Healthcare Provider Details

I. General information

NPI: 1578489449
Provider Name (Legal Business Name): FAIRLAND MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17351 MELFORD BLVD
BOWIE MD
20715-4457
US

IV. Provider business mailing address

12934 OLIVINE WAY # MD
SILVER SPRING MD
20904-5359
US

V. Phone/Fax

Practice location:
  • Phone: 718-708-0804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DIDAR ALAM
Title or Position: MD
Credential:
Phone: 718-708-0804